Clinical Characteristics and Neuroimaging Findings in Internal Jugular Venous Outflow Disturbance

Abstract

Recently, internal jugular vein stenosis (IJVS) is gaining increasing attention from clinical researchers due to a series of confounding symptoms that impair the quality of life in affected individuals but cannot be explained by other well-established causes. In this study, we aimed to elucidate the clinical features, neuroimaging characteristics and pathogenesis of IJVS, and explore their possible correlations, in attempt to provide useful clues for clinical diagnosis and treatment. Forty-three eligible patients with unilateral or bilateral IJVS confirmed by contrast-enhanced magnetic resonance venography of the brain and neck were enrolled in this study. Magnetic resonance imaging along with magnetic resonance angiography or computed tomography angiography was applied to identify the radiological pattern of parenchymal or arterial lesions. Cerebral perfusion and metabolism were evaluated by single-photon emission computed tomography (SPECT). Of the 43 patients (46.0 ± 16.0 years old; 30 female), 14 (32.6%) had bilateral and 29 had unilateral IJVS. The common clinical symptoms at admission were tinnitus (60.5%), tinnitus cerebri (67.6%), headache (48.8%), dizziness (32.6%), visual disorders (39.5%), hearing impairment (39.5%), neck discomfort (39.5%), sleep disturbance (60.5%), anxiety or depression (37.5%) and subjective memory decline (30.2%). The presence of bilateral demyelination changes with cloudy-like appearance in the periventricular area and/or centrum semiovale was found in 95.3% (41/43) patients. SPECT findings showed that 92.3% (24/26) patients displayed cerebral perfusion and metabolism mismatch, depicted by bilaterally and symmetrically reduced cerebral perfusion and increased cerebral glucose consumption. IJVS may contribute to alterations in cerebral blood flow and metabolism, as well as white matter lesion formation, all of which may account for its clinical manifestations.

Cervical spondylotic internal jugular venous compression syndrome

“…In the routine examination, narrowing of the jugular veins below the skull base is not an uncommon finding. Both clinical presentations and imaging features should be taken into consideration when clinicians attempt to make the diagnosis of IJVS. In this study, most of the patients with cervical spondylotic IJVS were at their middle age (57.4 ± 9.9 years), and the average age of symptom onset was approximately 10 years younger (46.4 ± 14.6 years).…”

“…Our study group discovered that some nonfocal neurological symptoms like headache, head noise, tinnitus, and visual impairment are tightly correlated to unilateral or bilateral IJVS, and balloon dilation with stenting in the stenotic segment may be a promising option to overcome nonimmunogenic and nonextrinsic compression IJVS‐induced jugular venous outflow impairment . Meanwhile, we also depicted the clinical characteristics and neuroimaging findings in IJVS in a previous publication . Accordingly, symptomatic IJVS should be viewed as a pathological disorder, which deserves more attention from clinicians due to the limited realization and the disabling or long‐lasting neurological symptoms that cannot be explained by other known diseases …”

“…Other extrinsic or nonextrinsic stenoses were excluded from this study as well. Risk factors for nonextrinsic stenoses have not been determined currently, whereas, our clinical practice implies that certain systemic disorders, such as autoimmunity diseases, hypertension and diabetes may be associated with venous wall anomalies of the IJV . Consequently, a total of 46 patients were involved.…”

“…All patients received standard medical therapy, including antiplatelets/anticoagulation, dehydration, and other symptomatic treatment to prevent against venous thrombosis, decrease intracranial hypertension, and relieve afflicted symptoms . As there is no consensus over the surgical intervention for such osseous impingement, only patients who strongly requested surgery were performed with cervical lateral mass resection and subsequent stenting/balloon dilatation.…”

Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency

“…The lesions for the type of CCSVI are commonly present in IJV with abnormally dilated paraspinal collateral veins. The diagnostic delay could interfere with the normal life of the involved patients for a long time (8). Moreover, the clinical symptoms could be relieved after the correction of CCSVI with medical and surgical treatment (9,10).…”